Results help

[Themax]

B12 1124 ng_l (197-771)

Folate 6.5 ug/l (3.9-26.8

Free t4 20.2 pmol/L (10.6-23.2)

TSH.3.04 mU/L (0.3-4.2

Ferritin 48.0 ug/l (30-400)

Transferring 2.3 g/l (2-3.6)

Iron 22.8 umol/L (10-30)

Transferrin saturation 39.7% (0-55)

[SlowDragon Administrator]

Looking at previous posts you seem to be on 125mcg Levothyroxine after RAI?

Presumably you had Graves?

How do you feel?

How long have you been on this dose?

Do you always get same brand of Levothyroxine

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you did the test?

Thyroid results - TSH is likely too high for someone on Levothyroxine, but FT4 is right at top of range. You need TSH, FT4 and FT3 tested together

NHS often refuses to test FT3

Look at getting tested privately via Medichecks or Blue Horizon

You also need vitamin D tested

vitamindtest.org.uk

B12 is high

Presumably you have been supplementing?

Folate on low side. You might benefit from supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).

Or Jarrow B-right is popular choice, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Ferritin is on the low side. Perhaps eating liver or liver pate once a week, or other iron rich foods should help improve levels

Daily vitamin C may help improve iron absorption

If you have Graves' disease have you tried strictly gluten free diet?

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

[Themax in reply to SlowDragon]

Thanks Slow Dragon yeah I was Hyper but no one ever mentioned Graves. But lot of things going on, health wise and would all make sense. few said I prob still have the Antibodies, plus my mother apparently had it and it was always with her till she died at 84. Will look into all the I go etc and get vitamins sorted. I never took any meds 24 hrs prior to test like you had said before. Never any probs with Thyroxine the 25mg is Teva and the 100mg is north star brand I think. My platelet white blood and lypocete all came back low and have to contact surgery, not sure what they all mean. But will let you know, they are closed for training today. Thanks for your help.

[SlowDragon Administrator in reply to Themax]

Many many patients react extremely badly to Teva

Suggest you request a different brand of 25mcg

North Star don't make a 25mcg. You could have 50mcg North Star and cut in half. Or take 100mcg one day and 150mcg the next (use a weekly pill dispenser if doing this )

List of brands available in the UK

thyroiduk.org.uk/tuk/treatm...

Posts about Teva

A Marmite brand, a few love it, many hate it

healthunlocked.com/search/p...

[Themax in reply to SlowDragon]

Thanks again will see if I can get Teva ones changed due a script, but I don't have any problems with Thyroxine. Been on this dose for about 14 yrs. I feel not to bad, although the biggest prob is the mood when I just blow and then takes weeks to get the guilt etc of what I did and said, but I doubt it will ever leave, will be getting test tomorrow on Medichecks.

[SlowDragon Administrator in reply to Themax]

Surprisingly Gluten intolerance can cause anger and rage

glutenfreeworks.com/blog/20...

Gluten intolerance is extremely common with Hashimoto's or Graves

[Themax in reply to SlowDragon]

Will have to look into Gluten free, see, andy idea how it would effect Divaticulitus, although I eat quite well and stopped bread etc although have upped fiber but it just doesn't settle without tabs

[Themax in reply to SlowDragon]

Went back to GP today, they Def do not have a clue how Thyroid effects people. Said my levels are fine and have been for a few weeks.? Anyway asked for an Antibody test to see if I have Graves Antibodies still, but said they had done that, which they haven't. So said he would do that test and few others. Then mentioned counselling etc but that doesn't stop my issues. Also mentioned other probs I had, but tells me sugar etc can cause them. Would change GP but they are all the same it seems. Hopefully get a printout

[SlowDragon Administrator in reply to Themax]

Yes, most medics don't get the complications of thyroid disease

Gut is almost always involved

Gluten and diverticulitis may be linked

healthyeating.sfgate.com/si...

[Themax in reply to SlowDragon]

No I have seen 3 last few weeks and only one had limited knowledge. Left getting test on Medichecks yesterday to see what they said today, so wait to see what all the tests and results are. Going to get a gluten free diet sorted out. My Grandson is Coeliac and diagnosed at about 8 mths. So will get my daughter to help me out food wise, what to get and meals.

[SlowDragon Administrator in reply to Themax]

It's much easier than you might imagine

Lots of good gluten free options. ....including lots of different beers available

Get use to reading labels

Watch for cross contamination....don't share butter, jams, get a gluten free toaster if toasting gluten free bread.

B free gluten free bread makes good toast

Gluten free "thins" by M&S or warburtons make good sandwiches

Eating out is easy. Eating at friends can be tricky

[Themax in reply to SlowDragon]

Thanks Slowdragon, beers not a prob as I don't drink it, odd btl of white zinfandel have to check label, and same with cider but only occasionally, and do not eat much Bread. Just as long as I get Fiber etc for Diverticulitis

[SlowDragon Administrator in reply to Themax]

Cider and wine are fine 🍷

[Themax in reply to SlowDragon]

Fantastic had not been drinking cider because of alcohol, so some good new lol

[Themax in reply to SlowDragon]

Been chatting to my daughter who's son is Coeliac, and going through what we eat now, and most is gluten free, bisto oxo not but we would only have gravy couple times a year so no big deal, bread we would only have couple times a week so that's drf out and need to change branded cereal to Asda own as most of what we have would be gluten free in their own brand. Don't have cakes etc very often anyway. And food wise we make our own sauces mostly so any being bought needs to be checked, and pizza out unless we buy gluten free base and make our own. Thanks for all the advice.

[Themax in reply to SlowDragon]

Reading one of your replies on another post, I maybe won't hold my breath on a TSI or TRAB test, but live in hope. So back to medi checks prob to get it. Reading TSH with being high while taking Thyroxine, would I be correct in thinking that I might need Thyroxine increased. Taking Vitd And B complex so it might help

[SlowDragon Administrator in reply to Themax]

To be adequately treated on Levothyroxine TSH definitely needs to be under 2

Many need TSH under 1

A significant number need TSH lower than that

The most important results are FT4 and FT3

Typically FT4 in top third of range and FT3 at least half way in range

Vitamins need to be optimal

Always stick to same brand of Levothyroxine once you work out which one suits you best

Many people find different brands are not interchangeable

Often pharmacies are very unhelpful on this, we recommend getting the actual paper prescription from GP. This enables you to take prescription wherever is necessary to get the brand you need. Small independent pharmacies are often far more helpful

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many especially after RAI

rcpe.ac.uk/sites/default/fi...

british-thyroid-association...

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

[Themax in reply to SlowDragon]

Hi Slowdragon, got my bloods back, but seems most are nothing to do with Thyroid done lot diabetes, liver, cardiovascular, testosterone, cholesterol. . One was Thyroid Peroxidase Ab/Conc. It is 23 IU/ml (34). Daughter worked out what we are eating to see what we need to stop eating, and it seems most of our diet is Gluten free, no scones or bread don't eat much but its out, and need cereal brand changed, but she says it's pretty easy as most is non gluten, so we plan to start. And got BComplex with Folate, vitC and Das well., my B12 is still high so cutting it out as B12 in the B complex

[SlowDragon Administrator in reply to Themax]

Frequently they test hundreds of things ...almost everything except

TSH, FT3, FT4

NHS almost always refuses to test TG antibodies if TPO are negative

Also NHS rarely tests FT3 if TSH is within range

A GP probably can't order TSI or TRab antibodies

Private testing for suspected Graves - TSI or TRab antibodies

medichecks.com/thyroid-func...

Vitamin D, you can test here for £29

vitamindtest.org.uk

folate - was too low in original post - hopefully now improving with vitamin B complex

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

ferritin also on low side in original post. Eating liver or liver pate once a week should help improve.

B12 is almost always above range if we take supplements

[Themax in reply to SlowDragon]

Thankyou again Slowdragon, thought that Thyroid Peroxidase Ab/Conc. It is 23 IU/ml (34). One was ruling out Antibodies, but obv need all done for a clearer pic. So Medi Checks tomorrow. Yeah B12 in the Bcomplex, was going to stop the tablet B12 I have been taking..will post any results I get, would you like to be my GP as I have got more info from you than 4 visits to my GPS. I think a lot of tests was him trying to prove himself right, as our GPS don't like being told what you think it might be.

[SlowDragon Administrator in reply to Themax]

I was tested for MS, pituitary tumour, adrenal tumour, muscle wasting diseases, etc etc etc ....you get the picture

It was actually gluten intolerance, multiple vitamin deficiencies as result and Heterozygous DIO2 gene

Addition of tiny dose of T3 was a miracle

More on my profile

[Themax in reply to SlowDragon]

i get the picture, and you could probably have told him lol

[SlowDragon Administrator in reply to Themax]

You probably only need the vitamin B complex as this contains B12.

See how you get on without separate B12